Non Medical Prescribing Non Medical Prescribing

Making a DifferenceMaking a Difference

Marie BrazilMarie BrazilConsultant Pharmacist Haematology ServicesConsultant Pharmacist Haematology Services

Wirral University Teaching Hospital NHS Wirral University Teaching Hospital NHS Foundation TrustFoundation Trust

BackgroundBackground

Haematology ….. Wirral from 1994Haematology ….. Wirral from 1994 Qualified as Supplementary Prescriber Qualified as Supplementary Prescriber

July 2004July 2004 Inpatient prescribing and dischargesInpatient prescribing and discharges June 2007 Outpatient ClinicsJune 2007 Outpatient Clinics Independent Prescriber Feb 2008Independent Prescriber Feb 2008

For patientsFor patients

Ensuring fair access to healthcare is at the Ensuring fair access to healthcare is at the heart of Lord Darzi’s recent report on the heart of Lord Darzi’s recent report on the

future of the NHSfuture of the NHS

“Ensuring timely access

There was a strong message that people can still find it difficult to access services. Improving access is a priority articulated in every vision, across every pathway of care. Each region will continue to improve the quality of access by reducing waiting times for treatment, …….” …….”

High Quality Care For All

NHS Next Stage Review Final Report June 2008 June 2008

Service redesignService redesign

++

Use of skills of the whole MDTUse of skills of the whole MDT

= Improved access= Improved access

Previous Clinic StructurePrevious Clinic Structure

Monday (Haem Day Ward)Monday (Haem Day Ward) Consultant 1 plus RegistrarConsultant 1 plus Registrar

Tuesday (Haem Day Ward)Tuesday (Haem Day Ward) Consultant 2 plus RegistrarConsultant 2 plus Registrar

Wednesday Wednesday (Outpatient Department) Anticoagulant Clinic(Outpatient Department) Anticoagulant Clinic (Haem Day Ward) Nurse led bone marrow clinic(Haem Day Ward) Nurse led bone marrow clinic

Thursday (Outpatient Department)Thursday (Outpatient Department) Consultant 1 and Consultant 2 plus RegistrarConsultant 1 and Consultant 2 plus Registrar

New StructureNew Structure Monday (Haem Day Ward)Monday (Haem Day Ward)

Consultant 1 plus RegistrarConsultant 1 plus Registrar Tuesday (Haem Day Ward)Tuesday (Haem Day Ward)

Consultant 2 plus RegistrarConsultant 2 plus Registrar Wednesday Wednesday

(Outpatient Department) Anticoagulant Clinic(Outpatient Department) Anticoagulant Clinic (Haem Day Ward) Nurse led bone marrow clinic(Haem Day Ward) Nurse led bone marrow clinic

Thursday Thursday (Outpatient Department) Consultant 1 and Consultant 2 (Outpatient Department) Consultant 1 and Consultant 2 plus plus

Pharmacist and Clinical Nurse SpecialistPharmacist and Clinical Nurse Specialist (Haem Day Ward) Consultant 3(Haem Day Ward) Consultant 3 plus Registrarplus Registrar

Friday (Haem Day Ward)Friday (Haem Day Ward) Consultant 3 plus Pharmacist and Clinical Nurse SpecialistConsultant 3 plus Pharmacist and Clinical Nurse Specialist

Follow up patients seen by specialist Follow up patients seen by specialist nurses or pharmacistnurses or pharmacist

PharmacistPharmacist MDS, Chronic anaemiaMDS, Chronic anaemia Essential ThrombocythaemiaEssential Thrombocythaemia CML (molecular monitoring)CML (molecular monitoring) ITPITP HaemochromatosisHaemochromatosis

Increase in available clinic slotsIncrease in available clinic slots

Patient Satisfaction SurveyPatient Satisfaction Survey

March 2008 Brief survey n=40March 2008 Brief survey n=40 98% of patients completely confident with 98% of patients completely confident with

serviceservice 2% less confident than when seeing a 2% less confident than when seeing a

doctordoctor Quality of consultation rated 100%Quality of consultation rated 100%

Patient Expectation SurveyPatient Expectation Survey

Jan/ Feb 2009 (LJMU)Jan/ Feb 2009 (LJMU) More representative sample of patients More representative sample of patients

managed and not managed by managed and not managed by pharmacists in clinicpharmacists in clinic

Patients happy and confident in servicePatients happy and confident in service Others more confident with traditional Others more confident with traditional

rolesroles

IndividualsIndividuals

Professional bodiesProfessional bodies

ProfessionallyProfessionally

RewardingRewarding

ChallengingChallenging

Lead by example (NPSA)Lead by example (NPSA)

Role modelRole model

Greater understandingGreater understanding

““Walk a mile in another man’s shoes”Walk a mile in another man’s shoes”

Greater integration / a more confluent Greater integration / a more confluent serviceservice

Blurring the LinesBlurring the Lines

Who checks the checker?Who checks the checker?

Chemotherapy – outpatient prescribing of Chemotherapy – outpatient prescribing of oral agents.oral agents.

Inpatient chemotherapy – prescribed by Inpatient chemotherapy – prescribed by consultant medics and accredited consultant medics and accredited registrarsregistrars

Never say never…Never say never…

Traditional to innovativeTraditional to innovative

Background to forefrontBackground to forefront

Ripples are little waves and making waves Ripples are little waves and making waves can be funcan be fun

Any Questions?Any Questions?